After prostate cancer has been diagnosed, staged, and graded, the next step for the physician is to evaluate the health condition weighing the pros and cons of treatment options. The physician would suggest a custom-made treatment plan. There are four standard treatment options.
1. Watchful Waiting
In certain men more often in the old men, active treatment may be withheld while the patient is closely monitored for signs of change in their disease or the development of new symptoms. If at any time that the cancer is progressing, active treatment may then be started. This kind of "wait and see" approach is chosen most often in men who are older and have other significant medical problems.
2. Radiation Therapy
Radiation therapy deploys x-rays to kill cancer cells by damaging the DNA that is needed by cells to grow and divide. At the same time focus on minimizing its effect on healthy nearby tissue. There are two ways of radiation theray:
* External beam radiation - A source of radiation outside of the body is used.
* Brachytherapy - A source of radiation is implanted or inserted into the body.
3. Hormonal Therapy
Male sex hormones such as testosterone are produced naturally within the body. Hormonal therapy is to block the production or effects of these hormones. More often hormonal therapy is used in conjunction with other form of cancer treatments, e.g.radiation.
Examples of hormone therapy medications:
* Anti-androgens (flutamide, nilutamide)
* LH-RH agonists (leuprolide, goserelin
* Adrenal gland blockers (ketoconazole, aminoglutethimide)
* Estrogens
4. Surgery
The primary goals of surgery are to remove the cancerous tissue from the body, to remove other structures that may contain cancer such as lymph nodes, and to minimize damage to any normal, cancer-free tissues and organs that are nearby.
- Radical Prostatectomy - The prostate,
some surrounding tissue, and the seminal vesicles are all completely
removed. This is, by far, the most commonly chosen type of surgery for
prostate cancer.
* Retropubic Radical Prostatectomy - The initial incision by the surgeon is made in the lower abdomen between the navel and just above the penis. From this site, lymph nodes near the prostate can also be removed and examined for evidence of cancer.
* Perineal Radical Prostatectomy - The initial incision by the surgeon is made in the skin between the anus and scrotum. From this site, lymph nodes cannot be removed, so a second incision is sometimes needed in the lower abdomen to remove them.
Less Common Treatment Options Besides the four primary types of prostate cancer treatments:
1. Cryotherapy
This technique utilizes special equipment to freeze the prostate in order to kill cancer cells.
2. Chemotherapy
Chemotherapy is not commonly used to treat prostate cancer, but may be an option in certain men whose disease has spread outside of the prostate.
3. HIFU
HIFU
stands for High Intensity Focused Ultrasound. It is a technology that
utilizes ultrasound waves that have been focused onto a very small area
to generate intense heat at that site. Not yet approved for use in
the United States.
4. Robot-Assisted Surgery
Robotic instruments have been developed to assist surgeons in removing
the prostate. This advance has been met with a great deal of excitement
and discussion, but has its own shortcomings as well.
Sources:
Adolfsson
J, Steineck G, Whitmore WF Jr Recent results of management of palpable
clinically localized prostate cancer. Cancer 72 (2):
310-22,
1993. Duncan W, Warde P, Catton CN, et al. Carcinoma of the prostate:
results of radical radiotherapy (1970-1985) Int J Radiat Oncol Biol
Phys 26
(2): 203-10, 1993. Potosky AL, Legler J, Albertsen PC,
et al. Health outcomes after prostatectomy or radiotherapy for prostate
cancer: results from the Prostate Cancer Outcomes Study. J Natl Cancer
Inst 92 (19): 1582-92, 2000.Whitmore WF. Expectant management of
clinically localized prostatic cancer. Semin Oncol 21 (5): 560-8, 1994.
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